If you don’t want to get pregnant, you will need to choose a method of contraception, such as going on birth control. Infertility is not birth control. This can be a surprising and frustrating realization for couples that have spent months and years trying to get pregnant. Do you really need contraception after a diagnosis of infertility? For what reason might a fertility-challenged couple decide or need to use birth control? Could going on hormonal birth control further harm your fertility, making it even harder to conceive if you choose to try to have another child in the future?
Can You Get Pregnant If You’re Infertile?
Yes, even if you have been diagnosed with infertility, you may be able to get pregnant on your own. This partially depends on the cause of your infertility. It’s also important to know the difference between infertility and sterility. With infertility, your odds of conception are lower than the general population. But it’s not necessarily impossible for you to conceive on your own. Sterility, on the other hand, is when you are incapable of conceiving (or impregnating your partner) without medical assistance. For example, if both of a woman’s fallopian tubes have been removed or are completely blocked, she is sterile. Or, if a male has zero sperm count (azoospermia), he is sterile. Conceiving without the help of assisted reproductive technology would be impossible in these situations. Whether it’s low sperm count or poor ovulation, there often remains a possibility of natural conception, even if that chance is low. Researchers have looked into these odds.
Odds of Conceiving After Infertility
In one study, couples that had IVF treatment in French fertility treatment centers were sent follow-up questionnaires seven to nine years later. The surveys were sent to both those who conceived with IVF and those who did not. Out of 1,320 couples that conceived with IVF, 17% (or 218 couples) went on to conceive naturally within the next seven to nine years. Out of 814 couples that had not had success with IVF, 24% (or 193 couples) went on to conceive spontaneously. Researchers found that those with unexplained infertility and those who were younger were more likely to get pregnant without medical help post-IVF. Another study found a similar spontaneous conception rate; 21.6% of couples went on to get pregnant without fertility treatments in the years after they received IVF. Women diagnosed with primary ovarian insufficiency (also known as premature ovarian failure) often require IVF treatment with an egg donor to get pregnant. However, you may be surprised to hear that 5% to 10% of these same women go on to conceive with their own eggs, sometimes with the help of fertility drugs but also sometimes spontaneously. No one is clear exactly why. There are a few caveats to keep in mind:
First, many of these studies rely on couples returning mailed surveys. Those who are happy to have conceived may be more likely to respond. Therefore, happy-ending stories may be over-represented.Secondly, these percentages don’t provide a per-month-odd ratio, which is likely very low. These are the percentages that managed to conceive over several years’ time.The bottom line is this: you probably don’t want to forego fertility treatments based on these statistics. However, unless your doctor tells you otherwise if you don’t want to get pregnant, you shouldn’t rely on your infertility as birth control. (Yes, even if you needed an egg donor previously to conceive.)
Reasons for Birth Control After Infertility
Making the decision to go on birth control or use contraception after infertility can be challenging and controversial. After all the struggle of trying to get pregnant, why would you want to actively prevent pregnancy from happening? There are several reasons. For those who have conceived (with or without the help of fertility treatments), reasons to actively prevent pregnancy include:
Being unsure if you want more kids: Maybe you just don’t know if you want more. You may choose to prevent it until you decide.Deciding to stop building their family: Whether you’re stopping after one or five children, you can decide when you’re finished having kids.Medical advice against pregnancy/birth: Your doctor may advise you not to get pregnant, for a number of reasons.Spacing children: It’s a legitimate desire to not want two very young children at once.
For those who have not conceived after infertility, reasons to actively prevent pregnancy include:
Deciding on a childfree life: To have peace and resolution, you may choose to use contraception after deciding on a childfree life after infertility. Medical advice against pregnancy/birth: Your situation may change, and your doctor may advise you not to continue trying to conceive. Taking a temporary break from trying to conceive: It can be very difficult to emotionally recover from the stress of trying to conceive if the possibility of pregnancy still exists.
Using contraception after infertility can feel strange. It’s not uncommon for men and women to think that they should “just let things happen” after so much struggle. Some even feel guilty for actively preventing, thinking they are somehow rejecting the idea of a “miracle” baby. It is often the only way to move on or regain peace of mind. This is worth as much, if not more, than the possibility of a “surprise.”
Will Birth Control Harm My Fertility?
Particularly for those who may want to try to get pregnant again, the concern that going on birth control may harm their future fertility can keep them from even considering contraception. Here’s the good news: The majority of the research on birth control shows that hormonal birth control does not cause infertility. Here’s the not-so-good news: A few small studies show a slight impact on some fertility factors. While these effects seem to be temporary, they may be more likely to occur in women who have fertility problems. One study found that previous birth control use may cause a thinner endometrial lining, but this didn’t seem to impact pregnancy rates. Another study found that some women experience slightly irregular cycles for up to nine months after stopping the pill. This doesn’t mean you shouldn’t consider hormonal birth control, but it is worth discussing with your doctor. There are some instances when your doctor may recommend hormonal birth control. For example, if you had surgery to remove endometrial lesions, hormonal birth control may slow down the build-up of new endometrial deposits.
Depo-Provera
One form of hormonal birth control that you should avoid if you have any intention of trying again within two years is the Depo-Provera (or depot medroxyprogesterone acetate, or DMPA) shot. While other forms of birth control typically impact your fertility for a few months after stopping, the shot can continue to work up to 18 months after your last injection. If you’re worried about the possible adverse effects of hormonal contraception, you can use a barrier method instead. Condoms or a diaphragm with spermicide may be better choices.
